慢性阻塞性肺疾病（COPD）重症监护患者乳酸与白蛋白比值和28天全因死亡率的关系：动脉血和外周静脉血乳酸均可作为预测指标吗？

Association Between Lactate-to-Albumin Ratio and 28-Day All-Cause Mortality in Critical Care Patients with COPD: Can Both Arterial and Peripheral Venous Lactate Serve as Predictors?

作者信息

Zhao Kelan, Zhou Linshui, Ni Yeling, Tao Jieying, Yu Ziyu, Li Xiaojuan, Wang Lu

机构信息

Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, Zhejiang, People's Republic of China.

Department of Scientific Research, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, Zhejiang, People's Republic of China.

出版信息

Int J Chron Obstruct Pulmon Dis. 2025 May 11;20:1419-1434. doi: 10.2147/COPD.S503625. eCollection 2025.

DOI:10.2147/COPD.S503625

PMID:40376192

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12080483/

Abstract

BACKGROUND

Lactate-to-albumin ratio (LAR) has been reported as a useful predictor for multiple critical illnesses. However, the association between LAR and mortality in patients with chronic obstructive pulmonary disease (COPD) remains unclear. This study aims to clarify the correlation between LAR and 28-day all-cause mortality in patients with COPD and to investigate whether LAR calculated using arterial lactate (AL) or peripheral venous lactate (PVL) can serve as predictive indicators.

METHODS

A total of 1428 patients from the Medical Information Mart for Intensive Care (MIMIC) IV database (version 2.2) and 2467 patients from the eICU Collaborative Research Database (eICU-CRD, version 2.0) were included in this study. Propensity score matching (PSM) method was conducted to control confounders. Cox proportional hazards model, Kaplan-Meier survival method, subgroup analysis and receiver operating characteristic (ROC) analysis were performed to assess the predictive ability of LAR. To verify our hypothesis, data from the two databases were analyzed individually.

RESULTS

After adjusting for covariates, LAR calculated using either AL (MIMIC IV, HR = 1.254, 95% CI, 1.013-1.552, P = 0.038) or PVL (eICU-CRD, HR = 1.442, 95% CI, 1.272-1.634, P < 0.001) was independently associated with 28-day all-cause mortality in COPD patients. Kaplan-Meier analysis showed that patients with higher LAR value had significantly higher all-cause mortality (all P < 0.05). This association was consistent across subgroup analyses. In addition, the ROC analysis suggested that LAR calculated using PVL may have better predictive performance compared to using AL.

CONCLUSION

LAR calculated using both AL and PVL can independently predict the 28-day all-cause mortality after ICU admission in patients with COPD and higher level of LAR is related to higher mortality risk.

摘要

背景

乳酸与白蛋白比值（LAR）已被报道为多种危重病的有用预测指标。然而，LAR与慢性阻塞性肺疾病（COPD）患者死亡率之间的关联仍不清楚。本研究旨在阐明COPD患者中LAR与28天全因死亡率之间的相关性，并调查使用动脉血乳酸（AL）或外周静脉血乳酸（PVL）计算的LAR是否可作为预测指标。

方法

本研究纳入了来自重症监护医学信息数据库（MIMIC）IV数据库（版本2.2）的1428例患者和来自电子重症监护病房协作研究数据库（eICU-CRD，版本2.0）的2467例患者。采用倾向评分匹配（PSM）方法控制混杂因素。进行Cox比例风险模型、Kaplan-Meier生存方法、亚组分析和受试者工作特征（ROC）分析以评估LAR的预测能力。为验证我们的假设，对两个数据库的数据分别进行了分析。

结果

调整协变量后，使用AL计算的LAR（MIMIC IV，HR = 1.254，95% CI，1.013 - 1.552，P = 0.038）或PVL计算的LAR（eICU-CRD，HR = 1.442，95% CI，1.272 - 1.634，P < 0.001）均与COPD患者28天全因死亡率独立相关。Kaplan-Meier分析显示，LAR值较高的患者全因死亡率显著更高（所有P < 0.05）。这种关联在亚组分析中是一致的。此外，ROC分析表明，与使用AL相比，使用PVL计算的LAR可能具有更好的预测性能。